Long-term mesh erosion rate following abdominal robotic reconstructive pelvic floor surgery: a prospective study and overview of the literature

Abstract

Introduction and hypothesis The use of synthetic mesh in transvaginal pelvic floor surgery has been subject to debate internationally.Although mesh erosion appears to be less associated with an abdominal approach, the long-term outcome has not been studied intensively. This study was set up to determine the long-term mesh erosion rate following abdominal pelvic reconstructive surgery. Methods A prospective, observational cohort study was conducted in a tertiary care setting. All consecutive female patients who underwent robot-assisted laparoscopic sacrocolpopexy and sacrocolporectopexy in 2011 and 2012 were included. Primary outcome was mesh erosion. Preoperative and postoperative evaluation (6 weeks, 1 year, 5 years) with a clinical examination and questionnaire regarding pelvic floor symptoms was performed. Mesh-related complications were assessed using a transparent vaginal speculum, proctoscopy, and digital vaginal and rectal examination. Kaplan-Meier estimates were calculated for mesh erosion. A review of the literature on mesh exposure after minimally invasive sacrocolpopexy was performed (≥12 months' follow-up).Results Ninety-six of the 130 patients included (73.8%) were clinically examined. Median follow-up time was 48.1 months (range 36.0-62.1). Three mesh erosions were diagnosed (3.1%; Kaplan-Meier 4.9%, 95% confidence interval 0-11.0): one bladder erosion for which mesh resection and an omental patch interposition were performed, and two asymptomatic vaginal erosions (at 42.7 and 42.3 months) treated with estrogen cream in one. Additionally, 22 patients responded solely by questionnaire and/or telephone; none reported mesh-related complaints. The literature, mostly based on retrospective studies, described a median mesh erosion rate of 1.9% (range 0-13.3%). Conclusions The long-term rate of mesh erosion following an abdominally placed synthetic graft is low.

Advanced Cystocele is a Risk Factor for Surgical Failure after Robotic-assisted Laparoscopic Sacrocolpopexy

“…All cases were associated with Ethibond sutures, which created a sinus tract in the vaginal wall. Our findings are in agreement van Zanten et al [27], who reported a mesh erosion rate of 0-13.3% following minimally-invasive SCP. Risk factors for erosion have included total hysterectomy [9,25,28],…”

Perineorrhaphy Compared With Pelvic Floor Muscle Therapy in Women With Late Consequences of a Poorly Healed Second-Degree Perineal Tear

“…70 These procedures, however, require both high-technology operating facilities, as well as experienced surgeons, and comes with a median mesh erosion rate of 2-5% . 163,164 In summary, there are many different surgical treatment options in women with a prolapse of the middle compartment. No guidelines currently exist to guide the choice of technique.…”

Supracervical Hysterectomy Is Protective against Mesh Complications after Minimally Invasive Abdominal Sacrocolpopexy: A Population-Based Cohort Study of 12,189 Patients

“…Our findings are consistent with the estimation by van Zanten et al, who reported an overall median 1.9% mesh reoperation rate following MISC. 12 The overall mesh complication rate after MISC has varied widely in the literature, ranging from 0% to 10.5%, and has been shown prior to be dependent on the type of hysterectomy performed. 6,8,12–14 The seminal Colpopexy and Urinary Reduction (CARE) trial randomized patients to ASC alone or ASC with a Burch colposuspension.…”